Using ambulance service PCRs to understand 999 call-outs to older people with dementia

Marina Buswell,Philip Lumbard,Carol Brayne,Claire Goodman,Jane Fleming,Dean Ayres

doi:10.12968/jpar.2016.8.5.246

Abstract

Objectives: To use local ambulance service patient care records (PCRs) at an aggregate level to study the use of emergency medical services (EMS) by older people with dementia in two English counties. To understand how and where in the PCR dementia is recorded. To measure the proportion of patients aged 75 and over who had an emergency (999) ambulance response who have dementia recorded in the PCR. To carry out a descriptive analysis of any associations with age, gender, reason for the call, time of call, residential status or call outcome. Methods: Four days of PCRs from two counties (UK) for patients aged 75 and over were reviewed and non-patient-identifiable data extracted. Data for the total number of call-outs for those days were obtained from the computer-aided dispatch (CAD) system. Results: In 4 days' records for Cambridgeshire and Hertfordshire (2 304 records), over one third of call-outs (830) were to patients aged 75 and over. Data were obtained from 358 paper records. Dementia was recorded on 14.5% of records and another 7.0% recorded details suggesting dementia or cognitive impairment. Around 15% of call-outs to ≥75-year-olds were to care homes. Ambulance crews attended higher proportions of ‘older old’ people than the local population percentages of 85 to 89-year-olds and ≥90-year-olds. The most common reason (27.5%) for a call-out was a fall. Conclusions: This is the first paper to look in detail at the numbers of older people with dementia seen by emergency ambulance crews as documented in PCRs. It gives a benchmark for others looking at ambulance service data and highlights possibilities and pitfalls of using ambulance service PCR data.

Highlights

Background/rationaleThere is a common narrative that urgent and emergency care of older people with dementia is not optimal
Dementia was recorded on 14.5% of records and another 7.0% recorded details suggesting dementia or cognitive impairment
The most common reason (27.5%) for a call-out was a fall. This is the first paper to look in detail at the numbers of older people with dementia seen by emergency ambulance crews as documented in patient care record (PCR)

Summary

Introduction

There is a common narrative that urgent and emergency care of older people with dementia is not optimal. There are anecdotal stories that older people with dementia are more likely to be taken to hospital because ambulance crews cannot assess them properly or access alternative services. A recent review found the use of ambulance services or EMS by older people with dementia is not well understood. The literature reviewed demonstrated a concern for this group, need for training for EMS staff and awareness that current services are not optimal (Buswell et al, 2014b). We set out to use aggregate data from ambulance service patient care records (PCRs) to understand 999 call-outs to older people (>75 years) with dementia, aware from the outset that dementia may not be consistently recorded

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